1. I am of childbearing age with inflammatory bowel disease, how do I prepare for pregnancy? We believe that most patients with inflammatory bowel disease can have a successful pregnancy. In order to have a better pregnancy, it is recommended that patients with inflammatory bowel disease should first visit a gastroenterology clinic before preparing for pregnancy so that the severity of the disease can be evaluated. The evaluation should include not only the questioning of symptoms, blood tests, but also endoscopy and imaging in some patients. Patients with stable disease can properly prepare for pregnancy. 2.When I start to prepare for pregnancy or get pregnant, how should I adjust the medications I usually use? Most people believe that “medicine is poisonous”, so the medications they usually use may affect the health of their future babies. I have seen patients (both male and female patients) who stopped taking all their medications in order to have a healthy baby properly. Here, I would like to say again! Again! Once again! Even if you have a strong desire to stop your medication, you should consult a gastroenterologist before deciding. The consequences of discontinuing medication are twofold: 1. the disease may not be controlled after discontinuation, which may result in a rapid deterioration of the disease and ultimately difficult to end; 2. the disease may recur during pregnancy and eventually affect the fetus. Let’s take a look at how patients in Western countries are coping with the medications used during pregnancy preparation and pregnancy. In the Toronto Consensus Opinion on the Management of Inflammatory Bowel Disease in Pregnancy, it is stated that patients who were on mesalazine, azathioprine and biologics should continue to use these medications to control their disease during pregnancy and preparation, as they are relatively safe. In contrast, patients who were previously using methotrexate to control their disease are not recommended to continue using this drug to maintain control of their disease because it has a lower safety profile in pregnancy, and may discontinue methotrexate and switch to another drug with a higher safety profile for 3 months before starting to prepare for pregnancy. The above drug adjustment plan is worthy of our reference. 3.What should I do if the disease relapses when I get pregnant? Pregnant patients with active and complicated inflammatory bowel disease should be seen in a tertiary care hospital where they can be seen by both gastroenterologists and obstetricians. If recurrence is suspected during pregnancy, in addition to blood tests, colonoscopy, ultrasound or magnetic resonance imaging will be performed if necessary to determine whether there is a recurrence of the disease. If the disease is clearly recurrent or exacerbated, treatment with hormonal or biological agents may be required. According to previous scientific studies, the use of hormones during pregnancy may lead to an increased rate of preterm delivery and postpartum infections in the fetus, while the above-mentioned risks are relatively small with biologics. It is worth noting that in this consensus opinion it is emphasized that surgery should not be abandoned simply because of pregnancy if the patient does have complications that require emergency surgery. This tells us a simple truth: if you keep the green hills, you will not be afraid of no firewood! Remember to keep it in mind. 4. Which type of delivery should I choose? It is currently considered that cesarean delivery is recommended for patients who have undergone previous IPAA (ileal pouch anastomosis) and for patients with active perianal disease. In other pregnancies, the decision to deliver vaginally can be made after discussion with the obstetrician. 5. I use so many drugs, can I breastfeed my baby? We encourage mothers to breastfeed. Mothers who have used mesalazine, hormones, azathioprine and biologics in the past can breastfeed. However, patients using methotrexate to control their disease should avoid breastfeeding for the reasons mentioned above: methotrexate is less safe for infants. 6. How should I use biologic therapy during pregnancy? Many patients with inflammatory bowel disease prefer to use biologics in preparation for and during pregnancy for reasons of disease control and pregnancy safety. It is generally considered relatively safe to use biologics during the first 22-24 weeks of pregnancy, so that they do not pass through the placenta into the baby’s body. Scientific studies have shown that the regulated use of biologics during pregnancy does not increase the rate of preterm birth or infection in the fetus, but experts generally agree that fetuses should avoid attenuated vaccines in the first 6 months of life.